Because of the nature of the variability of disseminated disease, presentation of either condition can easily mimic the other; however, ADEM tends to have neurologic signs and symptoms not typically present in MS, such as headache, nausea, vomiting, drowsiness, and meningismus
Approximately 75% of the patients in this case series reported visual disturbances or new onset headaches, and 12% had acute meningitis syndrome with fever and meningismus
1[degrees]F), in obvious distress from pain, and exhibited meningismus
The patient also endorsed nasal congestion and several episodes of palpitations over the few months prior to presentation but denied photophobia, meningismus
, facial asymmetry, weakness, and dysarthria.
4[degrees] C), and he had meningismus
, photophobia, conjunctivitis, and hepatosplenomcgaly.
Coccidioidal meningitis is the most severe complication of coccidioidomycosis and results from lymphohematogenous spread from the lung, manifesting as fever, headache, changes in sensorium, malaise, and meningismus
2) Unlike GAE caused by Acanthamoeba, PAM affects immunologically intact children and young adults, usually with a history of swimming in warm freshwater five to seven days prior to onset of febrile meningismus
mimicking bacterial meningitis.
In the first phase, the meningoencephalitic phase, patients may experience headache, meningismus
, seizures, muscle weakness, hemi- or paraparesis, and psychosis, which can occur after a prodrome of fever, malaise, headache, nausea, and vomiting.
vertigo, confusion, disorientation, amnesia, lethargy, hallucination, meningismus
, choreiform movements, ataxia, tremor, convulsions, hemiparesis, decerebrate posturing, locked-in syndrome, or coma); or unexplained illness [greater than]48 hours in duration associated with fever, diarrhea, nausea, vomiting, or abdominal pain and any one of the following laboratory values: 1) hemoglobin [less than]8 gm/dL; 2) platelets [less than ]100,000 [mm.
While some patients experience meningismus
as retrobulbar headaches exacerbated by eye movement, serious CNS involvement such as encephalitis is rare.
Two days later, he was hospitalized with fever, chills, pharyngitis, dyspnea, nonproductive cough, headache, myalgias, hemoptysis, epistaxis, diarrhea, nausea, emesis, meningismus
, and a lower-extremity rash.
6, 9, 10) CNS complications in RMSF and other severe SF infections may include ataxia, photophobia, transient deafness, focal neurologic deficits, meningismus
, meningoencephalitis, seizures, confusion, and coma.